MPZL1 upregulation promotes tumor metastasis and correlates with unfavorable prognosis in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC), accounting for 85% of all lung cancer, is one of the leading causes of cancer-related death worldwide. Previously, we demonstrated that MPZL1 gene amplification promotes liver cancer metastasis through activating Src/Cortactin pathway. However, the clinical relevance and biological roles of the MPZL1 gene in lung cancer are still unknown. Here, we found that MPZL1 expression upregulates in human NSCLC, which is partly due to the copy number amplification of this gene. Next, we observed that high MPZL1 expression correlates with unfavorable prognosis of NSCLC patients. We further demonstrated that ectopic MPZL1 overexpression promotes in vitro migratory but not proliferation and colony formation abilities of both H1299 and H460 cells. Consistently, we found that MPZL1 knockdown impairs the migratory abilities of A549 and H1775 cells. Moreover, we found that MPZL1 knockdown inhibits in vivo metastatic but not tumor growth abilities of the A549 cells. Additionally, a total of 297 differentially expressed genes (DEGs) were identified by RNA sequencing in A549 cells upon MPZL1 knockdown. By integrative analysis of DEGs regulated by MPZL1 in A549 cells and human NSCLC tissues, we revealed that COL11A1 is the potential effector gene that positively regulated by MPZL1 and correlates with poor prognosis of NSCLC patients. In conclusion, our work indicates that one of the mechanisms by which MPZL1 promotes NSCLC metastasis is through upregulating the COL11A1, and MPZL1 can be used as a biomarker to predict the prognosis of NSCLC patients.

Robotic-assisted thoracoscopic resection and reconstruction of the carina.

A 71-year-old man had experienced an irritating cough for 3 months. A diagnosis of squamous cell carcinoma in the carina was made from the bronchoscopic examination. The patient underwent a robotic-assisted resection and reconstruction of the carina. The patient's postoperative course was uneventful. This is the first description of the feasibility of robotic-assisted carina resection and reconstruction.

Factors distinguishing invasive from pre-invasive adenocarcinoma presenting as pure ground glass pulmonary nodules.

BACKGROUND: To investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules (pGGNs). METHODS: Clinical and computed tomography (CT) features of invasive adenocarcinomas (IACs) and pre-IACs were retrospectively compared in 641 consecutive patients with pGGNs and confirmed lung adenocarcinomas who had undergone postoperative CT follow-up. Potential predictors of prognosis were investigated in these patients. RESULTS: Of 659 pGGNs in 641 patients, 258 (39.1%) were adenocarcinomas in situ, 265 (40.2%) were minimally invasive adenocarcinomas, and 136 (20.6%) were IACs. Respective optimal cutoffs for age, serum carcinoembryonic antigen concentration, maximal diameter, mean diameter, and CT density for distinguishing pre-IACs from IACs were 53 years, 2.19 ng/mL, 10.78 mm, 10.09 mm, and - 582.28 Hounsfield units (HU). Univariable analysis indicated that sex, age, maximal diameter, mean diameter, CT density, and spiculation were significant predictors of lung IAC. In multivariable analysis age, maximal diameter, and CT density were significant predictors of lung IAC. During a median follow-up of 41 months no pGGN IACs recurred. CONCLUSIONS: pGGNs may be lung IACs, especially in patients aged > 55 years with lesions that are > 1 cm in diameter and exhibit CT density > - 600 HU. pGGN IACs of < 3 cm in diameter have good post-resection prognoses.

Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases.

BACKGROUND: Discuss an appropriate strategy for treatment of invasive thymoma invading adjacent great vessels. METHODS: A retrospective study on 25 patients with invasive thymoma invading neighboring great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radio-chemotherapy and follow-up were reviewed. RESULTS: Twenty of 25 (80%) patients with invasive thymoma underwent complete resection of the tumor along with vessel reconstruction. Intraoperatively, different types of operation were conducted, namely, brachiocephalic vein (BCV)-right atrial appendage (RAA) reconstruction in 11 cases, complex vessel reconstruction (more than one graft) in 1 case and superior vena cava (SVC)-SVC reconstruction in the remaining cases. Ringed polytetrafluoroethylene (PTFE) grafts were used for vessel reconstruction. Postoperatively, three cases suffered from pulmonary infection, and three cases had haemothorax, chylothorax and atelectasis, respectively. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Within the remaining patients, 11 cases (44%) experienced a relapse and finally 8 (32%) patients died. Compared to R1 resection group, R0 resection group had a better prognosis (Log-rank P=0.0196). The 3- and 5-year survival rates were 79.6% and 59.1%, with median survival time of 84 months. CONCLUSIONS: Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology method. Radical resection of the tumor with involved neighboring structures is the key to prolong overall survival for patients suffered from invasive thymoma.

RNF4-mediated SUMOylation is essential for NDRG2 suppression of lung adenocarcinoma.

N-Myc downstream-regulated gene 2 (NDRG2) protein is a tumor suppressor that inhibits cancer growth, metastasis and invasion. The ubiquitin ligase RNF4 integrates signaling by SUMO and ubiquitin through its selective recognition and ubiquitination of SUMO-modified proteins. We evaluated NDRG2 SUMOylation in lung adenocarcinoma cells and its underlying molecular mechanism. The results showed that NDRG2 is covalently modified by SUMO1 at K333, which suppressed anchorage independent adenocarcinoma cell proliferation and tumor growth. In human lung adenocarcinomas cells, RNF4 targeted NDRG2 to proteasomal degradation by stimulating its SUMOylation. Endogenous RNF4 expression was increased in human lung adenocarcinomas cells, and there was a concomitant upregulation of SUMO. These findings indicate that SUMOylation of NDRG2 is necessary for its tumor suppressor function in lung adenocarcinoma and that RNF4 increases the efficiency of this process.

Surgical treatment of thymoma: an 11-year experience with 761 patients.

OBJECTIVES: Thymomas are rare, and information regarding their surgical outcomes and possible prognostic factors is limited. In this study, we aimed to determine the clinicopathological characteristics of thymoma and estimate independent predictors of both overall and disease-free survival in thymoma patients. METHODS: We carried out a retrospective review of the clinicopathological characteristics and prognostic factors in 761 consecutive patients with pathologically confirmed thymoma treated in Shanghai Chest Hospital between January 2001 and December 2011. Survival was calculated using the Kaplan-Meier method and evaluated with log-rank tests. Multivariable analysis was performed using the Cox regression model. RESULTS: Complete follow-up information was available for 544 patients. The overall survival rate was 92.8% at 5 years and 90.5% at 10 years. The 5- and 10-year disease-free survival was 87.9 and 82.1%, respectively. On multiple Cox regression analysis, the Masaoka-Koga clinical stage [odds ratio (OR), 2.057; 95% confidence interval (CI), 1.454-2.911; P < 0.01] and sex (OR, 2.244; 95% CI, 1.115-4.519; P = 0.02) were found to be independent predictors of overall survival. The Masaoka-Koga clinical stage (OR, 2.127; 95% CI, 1.487-3.042; P < 0.01) and completeness of resection (OR, 2.935; 95% CI, 1.410-6.109; P < 0.01) predicted disease-free survival. CONCLUSIONS: The four-tiered Masaoka-Koga clinical stage is the most important prognostic factor, predicting not only overall survival but also disease-free survival after thymoma resection. Completeness of resection predicts disease-free survival, and the World Health Organization histological classification may not have significant prognostic implications.

Risk factors and consequences of perioperative reoperation in patients undergoing pulmonary resection surgery.

BACKGROUND: Perioperative reoperation is generally agreed to be necessary for the management of particular, severe complications. Understanding the incidence and predictors of perioperative reoperation enables surgeons to improve surgery quality. The objective of this study is to investigate the incidence, risk factors, and consequences of perioperative reoperation after pulmonary resection. METHODS: Data from patients who underwent perioperative reoperation after pulmonary resection surgery over the past 6 years in our department were reviewed retrospectively. A propensity score-matched analysis was performed to identify the association between reoperation and clinical outcomes. Univariate and multivariate analysis were used to analyze independent risk factors for the occurrence of reoperation. RESULTS: Overall, 19,304 patients with various lung diseases who underwent pulmonary resection surgeries were analyzed retrospectively, in which 195 patients (1.01%) required reoperation for severe perioperative complications. The leading cause for reoperation was hemorrhage in 143 (73.33%) patients, followed by bronchopleural fistula in 22 patients (11.28%). Further indications for reoperation were chyle leak, bronchial esophageal fistula, empyema, pulmonary congestion, air leak, and femoral artery embolism. The mortality of reoperation was 5.13% (10/195), with the highest (33.33%) among bronchial esophageal fistula and empyema. Patients undergoing reoperation had a higher mortality at hospital discharge, a longer duration of hospital stay, and a lesser incidence of postoperative transfusion (P < .05). Logistic regression indicated that patients with comorbidity, operative approach of open thoracotomy, and location of upper lobe were independent risk factors for the occurrence of early reoperation that performed within 24 hours (P < .05); however, operative approach showed no significance in terms of reoperation that happened beyond 24 hours (P = .087). CONCLUSION: The incidence of perioperative reoperation after pulmonary resection surgery is low and is mainly related to technical issues from the initial operation. The most common complication is hemorrhage, and the mortality of reoperation in bronchial esophageal fistula and empyema is higher than in others. Patients undergoing reoperation had a higher mortality at hospital discharge, a longer duration of hospital stay, and a lesser incidence of postoperative transfusion. Preoperative comorbidity, operative approach of open thoracotomy, and location of upper lobe were independent risk factors for the occurrence of early perioperative reoperation that was performed within 24 hours; approach of surgery was not significant in terms of reoperation that happened beyond 24 hours.

Evaluation of the proposed International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancies Interest Group (ITMIG) staging revisions in thymic well-differentiated neuroendocrine carcinoma patients.

OBJECTIVES: In 2014, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancies Interest Group (ITMIG) launched a worldwide Tumor Node Metastasis (TNM) staging proposal for the next edition of thymic tumours. The objective of the current study was to evaluate the proposed new staging system specific to the thymic well-differentiated neuroendocrine carcinoma (TWDNC). METHODS: From November 2003 to July 2014, 61 consecutive patients were enrolled in this study with pathologically confirmed TWDNC in Shanghai Chest Hospital. Clinical and pathological data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier and log-rank tests. Validity evaluation was addressed by Cox proportional hazards regression model, after adjusting for potential confounders and visually assessing the distinction of curves generated based on the staging system of Masaoka-Koga and the proposed TNM ones. RESULTS: Thymic carcinoids made up 4% of total thymic tumours in our institution. The 5-year overall survival (OS) rate and the disease-free survival (DFS) rate were 72 and 41%, respectively. Neither Masaoka-Koga staging system nor the proposed TNM system showed ordered appropriateness visually in survival curves and the prognostic demarcation between stages was poor on both OS and DFS. CONCLUSIONS: The IASLC/ITMIG suggested that the TNM and Masaoka-Koga staging systems fail to predict the clinical course of TWDNC patients. Collaborative effort is needed in the future staging validation as ITMIG recommended.

Combined identification of long non-coding RNA XIST and HIF1A-AS1 in serum as an effective screening for non-small cell lung cancer.

OBJECTIVE: Long non-coding RNAs (lncRNAs) XIST and HIF1A-AS1 have been shown to play important regulatory roles in cancer biology, and lncRNA-XIST and HIF1A-AS1 are upregulated in several cancers such as glioblastoma, breast cancer and thoracoabdominal aorta aneurysm, however, its value in the diagnosis of non-small cell lung cancer (NSCLC) is unclear. The aim of this study is to evaluate the clinical significance of serum XIST and HIF1A-AS1 as a biomarker in the screening of NSCLC. METHODS: Expression levels of lncRNA-XIST and HIF1A-AS1 in tumor tissues and serum from NSCLC patients were evaluated by quantitative real-time PCR, and its association with overall survival of patients was analyzed by statistical analysis. Moreover, the XIST and lncRNA-XIST expression correlation between tumor tissues and plasma was demonstrated by linear regression analysis. RESULTS: The levels of XIST (P < 0.05) and HIF1A-AS1 (P < 0.05) were significantly increased in tumor tissues or serum from NSCLC patients as compared to those of control group. Correlation of lncRNA-XIST or HIF1A-AS1 expression between tumor tissues and serum from the same individuals was confirmed in NSCLC patients. Moreover, serum levels of XIST and HIF1A-AS1 were significantly decreased after surgical treatment as compared to pre-operative. The ROC curves illustrated strong separation between the NSCLC patients and control group, with an AUC of 0.834 (95% CI: 0.726-0.935; P < 0.001) for XIST and 0.876 (95% CI: 0.793-0.965; P < 0.001) for HIF1A-AS1, however, the combination of XIST and HIF1A-AS1 yielded an AUC of 0.931 (95% CI: 0.869-0.990; P < 0.001), which was significantly improved as compared to XIST or HIF1A-AS1 alone. CONCLUSION: Our results demonstrated that increased serum XIST and HIF1A-AS1 could be used as a predictive biomarker for NSCLC screening, and that combination of XIST and HIF1A-AS1 had a higher positive diagnostic efficiency of NSCLC than XIST or HIF1A-AS1 alone.

The correlation of morphological features of chest computed tomographic scans with clinical characteristics of thymoma.

OBJECTIVES: Chest computed tomography (CT) scanning has been widely utilized in thymoma identification and staging as well as in follow-up monitoring for recurrence. However, the relationship between some CT imaging features and pathological types, clinical stage, completeness of resection, or prognosis in thymoma has not been well explored. METHODS: We retrospectively reviewed preoperative CT imaging for 238 thymoma patients, who had undergone thymectomy from October 2007 to December 2011. All CT parameters were assessed in each case based on clinical and pathological data. Survival analysis was performed by using the Kaplan-Meier and log-rank tests. RESULTS: Tumour contours (P = 0.008), homogeneity (P = 0.009), degree of enhancement (P = 0.013), fat plane obliteration with adjacent structures (P < 0.001), the presence of mediastinal lymphadenopathy (P = 0.010), irregular infiltration into the lung (P = 0.012) and tumour shape (P = 0.007) were associated with the World Health Organization (WHO) histological classification. Lobulated or irregular tumour contours (P < 0.001), presence of calcifications (P = 0.002), infiltration of surrounding fat (P < 0.001), irregular infiltration into the lung (P < 0.001), irregular infiltration into vascular (P < 0.001), more abutment of vessels (P < 0.001) and pulmonary changes adjacent to the tumour (P < 0.001) were associated with the more advanced Masaoka-Koga clinical stage. Tumour contours (P < 0.001), infiltration of surrounding fat (P = 0.008), irregular infiltration into the lung (P < 0.001) and degree of abutment of vessel circumference (P = 0.001) were associated with completeness of resection. With multivariate analysis, no CT image features could reliably predict on the overall or disease-free survival rate. CONCLUSIONS: CT imaging does have some features, which are significantly correlated with the WHO classification, the Masaoka-Koga clinical staging and the completeness of resection, although it has no definite role to evaluate preoperatively the survival rate of thymoma patients.

Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma.

BACKGROUND: Systematic lymph node dissection or sampling in all patients with clinical stage IA lung adenocarcinoma is currently controversial because the risk of lymph node metastasis is unclear. This study aimed to determine the predictive factors for lymph node metastasis in patients with clinical stage IA lung adenocarcinoma. METHODS: The records of 651 consecutive patients with clinical stage IA lung adenocarcinoma who underwent surgical resection were retrospectively reviewed. The tumors were categorized according to preoperative computed tomography findings as nonsolid (pure ground-glass opacity), part solid, or pure solid. Positron emission tomography with evaluation of the maximum standardized uptake value was performed in 219 patients. Clinicopathologic factors predicting hilar and mediastinal lymph node metastasis were identified by univariate and multivariate analyses. RESULTS: Tumors were classified as nonsolid in 55 patients (8.4%), part solid in 292 (44.9%), and pure solid in 304 (46.7%). Sixty-nine patients (10.6%) had lymph node metastasis, including 43 (6.6%) with pN1 and 26 (4.0%) with pN2. Ground-glass opacity status (part solid or pure solid), serum carcinoembryonic antigen level (>5 ng/dL), histologic subtype (acinar predominant, papillary predominant, micropapillary predominant, or solid predominant), and maximum standardized uptake value (>5) were identified as significant predictors of lymph node metastasis. CONCLUSIONS: Systematic lymph node dissection should be performed in patients with clinical stage IA lung adenocarcinoma with part-solid or pure-solid tumors, especially those with a carcinoembryonic antigen level exceeding 5 ng/dL and a maximum standardized uptake value exceeding 5. The intraoperative diagnosis of histologic subtype may help to identify patients in whom systematic lymph node dissection can be omitted.

Factors that predict lymph node status in clinical stage T1aN0M0 lung adenocarcinomas.

BACKGROUND: To identify patients in whom systematic lymph node dissection would be suitable, preoperative diagnosis of the biological invasiveness of lung adenocarcinomas through the classification of these T1aN0M0 lung adenocarcinomas into several subgroups may be warranted. In this retrospective study, we sought to determine predictive factors of lymph node status in clinical stage T1aN0M0 lung adenocarcinomas. METHODS: We retrospectively reviewed the records of 273 consecutive patients undergone surgical resection of clinical stage T1aN0M0 lung adenocarcinomas at Shanghai Chest Hospital, from January 2011 to December 2012. Preoperative computed tomography findings of all 273 patients were reviewed and their tumors categorized as pure GGO, GGO with minimal solid components (<5 mm), part-solid (solid parts >5 mm), or purely solid. Relevant clinicopathologic features were investigated to identify predictors of hilar or mediastinal lymph node metastasis using univariate or multiple variable analysis. RESULTS: Among the 273 eligible clinical stage T1aN0M0 lung adenocarcinomas examined on thin-section CT, 103 (37.7%) were pure GGO, 118 (43.2%) GGO with minimal solid components, 13 (4.8%) part-solid (solid parts >5 mm, five GGO predominant and eight solid predominant), and 39 (14.3%) pure solid. There were 18 (6.6%) patients with lymph node metastasis. Incidence of N1 and N2 nodal involvement was 11 (6.6%) and seven (2.6%) patients, respectively. All patients with pure GGO and GGO with minimal solid components (<5 mm) tumors were pathologically staged N0. Multivariate analyses showed that the following factors significantly predicted lymph node metastasis for T1a lung adenocarcinomas: symptoms at presentation, GGO status, and abnormal carcinoembryonic antigen (CEA) titer. Multivariate analyses also showed that the following factors significantly predicted lymph node metastasis for pure solid tumors: air bronchogram sign, tumor size, symptoms at presentation, and abnormal CEA titer. CONCLUSIONS: The patients of clinical stage T1aN0M0 lung adenocarcinomas with pure GGO and GGO with minimal solid components tumors were pathologically staged N0 and systematic lymph node dissection should be avoided. But systematic lymph node dissection should be performed for pure solid tumors or part-solid, especially in patients with CEA greater than 5 ng/mL or symptoms at presentation, because of the high possibility of lymph node involvement.

Safety and efficacy of thoracoscopic wedge resection for elderly high-risk patients with stage I peripheral non-small-cell lung cancer.

BACKGROUND: Elderly patients with severe cardiopulmonary and other system dysfunctions are unable to tolerate pulmonary lobectomy. This study aimed to evaluate the risk and efficacy of wedge resection under video-assisted thoracoscopic surgery (VATS) on elderly high-risk patients with stage I peripheral non-small-cell lung cancer (PNSCLC). METHODS: Elderly patients (≥70 years) with suspected PNSCLC were divided into high-risk group and conventional risk group. The high-risk patients confirmed in stage I by the examination of positron emission tomography computed tomography (PET-CT) and the postoperative patients in stage I PNSCLC with negative incisal margin were treated with VATS wedge resection. The conventional risk patients were treated with VATS radical resection and systematic lymphadenectomy. The clinical and pathological data were recorded. The total survival, tumor-free survival, recurrence time and style of patients were followed up. RESULTS: The operative time and blood loss of the VATS wedge resection group (69.4 ± 15.5 min, 52.1 ± 11.2 ml) were significantly less than those of the VATS radical resection group (128 ± 35.5 min, 217.9 ± 87.1 ml). Neither groups had postoperative death. The overall and tumor-free survival rate of the VATS wedge resection group within three years were 66.7% and 60.0%, and those of the VATS radical resection group were 93.8% and 94.1%, without significant difference (P > 0.05). The recurrence rates of the VATS wedge resection group and VATS radical resection group were 14.3% and 3.0%, without significant difference (P > 0.05). CONCLUSION: It is safe, minimally invasive and meaningful to perform VATS wedge resection on the elderly high-risk patients with stage I PNSCLC.

Surgical treatment and prognosis of thymic squamous cell carcinoma: a retrospective analysis of 105 cases.

BACKGROUND: Thymic squamous cell carcinomas are rare malignancies with limited information regarding results of surgery therapy. The objective of the current study was to evaluate their clinical and pathologic features and possible prognostic factors. METHODS: From February 2003 to December 2010, 105 consecutive surgical patients were enrolled in this study with pathologic confirmed thymic squamous cell carcinoma in Shanghai Chest Hospital. Clinical and pathologic data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier and log rank tests. Multivariate analysis was performed using the Cox regression model. RESULTS: The squamous cell subtype made up 73.4% of the thymic carcinomas and 16.1% of total thymic tumors. Four patients (3.8%) presented with myasthenia gravis. The 5-year overall survival rate and the disease-free survival rate were 59.5% and 57.6%, respectively. On multivariate analysis, only the completeness of resection (hazard ratio 3.692; 95% confidence interval: 1.827 to 7.464; p=0.001) was found to have significant impact on overall survival. Completeness of resection (hazard ratio 2.361; 95% confidence interval: 1.226 to 4.547; p=0.010) and chemotherapy (hazard ratio 0.307; 95% confidence interval: 0.134 to 0.704; p=0.005) were associated with disease-free survival. CONCLUSIONS: Complete resection not only predicts better overall survival but also extends disease-free interval after resection of thymic squamous cell carcinoma. Our results provide additional evidence supporting an alternative clinical stage specific for thymic carcinoma.

[Correlation analysis between imaging features and lymph node metastasis in T1a lung adenocarcinoma].

OBJECTIVE: To analyze the data of patients with clinical stage T1a lung adenocarcinoma and find the predictive factors associated with lymph node metastasis. METHODS: From January to June 2012, 271 patients with small nodules of peripheral lung adenocarcinoma were enrolled in the retrospective review. There were 105 male and 112 female patients, with an average age of (61 ± 11)years (range 32-85 years). The data were collected including age, gender, smoking history, carcinoembryonic antigen(CEA), imaging findings, surgical procedure, pleural involvement, symptoms, tumor size, pathological classification, pathologic stage, maximum standardized uptake value(SUVmax) and lymph node metastasis. The predictive factors of lymph node metastasis in clinical factors were detected by univariate and multivariate analysis. RESULTS: By preoperative thin-section CT, 35 patients were categorized as pure ground-grass opacity(GGO), 11 cases of atypical adenomatous hyperplasia, 24 cases of adenocarcinoma in situ, with no lymph node metastasis. Categorized as mixed ground-glass opacities in 89 patients, 84 patients (94.4%) had no lymph node metastasis, only 5 patients (6.0%) with lymph node metastasis. Categorized as solid nodules in 93 patients, a total of 28 cases (30.1%) had lymph node metastasis. There were statistically significant difference between three groups (χ(2) = 23.41, P < 0.001) . By univariate analysis, we found that the predictive factors of lymph node metastasis were as follows: tumor size > 1 cm (χ(2) = 9.021, P < 0.003) , imaging performance with mixed GGO or solid nodules (χ(2) = 23.41, P < 0.000) , CEA > 5 µg/L (χ(2) = 15.541, P < 0.000) and PET-CT SUVmax > 5 (χ(2) = 0.644, P < 0.000). By multivariate analysis, we found that imaging performance (mixed GGO or solid nodules) was the independent predictor of lymph node metastasis in clinical factors (OR = 166.116, 95%CI:18.161-25.19, P < 0.001) . CONCLUSIONS: Patients of pure GGO generally do not have lymph node metastasis. Tumor diameter > 1 cm, imaging findings with the mixed GGO or solid nodules, carcinoembryonic antigen CEA > 5 µg/L, PET-CT SUVmax > 5 are predictive factors of lymph node metastasis in which imaging is independent predictor.

Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer.

BACKGROUND: Thoracoscopic lobectomy for lung cancer has been widely accepted, but thoracoscopic segmentectomy remains controversial because of the complexity of the procedure and of the fear of increased local recurrence. This study compared outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy in patients with small-sized (≤2 cm) stage IA non-small cell lung cancer. METHODS: Between March 2006 and August 2011, 39 thoracoscopic segmentectomies and 81 thoracoscopic lobectomies were performed in 120 patients with small-sized (≤2 cm) stage IA lung cancer. Clinicopathologic factors, local recurrence rate, and survival rate were compared. RESULTS: The two groups were similar in age, sex, pulmonary function, and tumor size. There were no conversions from video-assisted thoracoscopic surgery to open or from segmentectomy to lobectomy. There were no in-hospital deaths. The two groups had a similar incidence of postoperative complications. Local recurrence rates were similar after thoracoscopic segmentectomy (5.1%) and thoracoscopic lobectomy (4.9%). No significant difference was observed in 5-year overall or disease-free survivals after thoracoscopic segmentectomy or thoracoscopic lobectomy. Multivariate Cox regression analyses showed tumor size was the only independent prognostic factor for disease-free survival. CONCLUSIONS: Thoracoscopic segmentectomy is a safe option and provides comparable oncologic results to thoracoscopic lobectomy for small (≤2 cm) peripheral stage IA non-small cell lung cancer. Tumor size is an independent prognostic factor of disease-free survival for stage IA patients with small-sized lesions.

[Immunosuppressive therapy after human lung transplantation].

OBJECTIVE: To summarize the diagnosis and treatment of acute rejection after lung transplantation and to discuss optimized immunosuppressive therapy. METHODS: Between November 2002 and June 2006, 16 patients underwent operations on lung transplantation, 7 cases on single-lung transplantation and 9 cases on bilateral-lung transplantation. Immunosuppressive therapy was new triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids, and (or) daclizumab. RESULTS: Eight cases in new triple drug maintenance regimen with daclizumab. There is no acute rejection in 6 months. Except 2 of the 8 cases died of early post-lung transplantation sever pulmonary edema and dysfunction, 3 of the rest 6 cases underwent acute rejection incident about 21.4% (3/14). CONCLUSION: In this group the new triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids, and (or) daclizumab acquired beneficial effect in preventing acute rejection after lung transplantation.